title: Validation of an objective device for assessing circumductive wrist motion.
abstract: OBJECTIVE
  Circumduction of the wrist consists of a circular motion combining flexion, extension, and radioulnar deviation without simultaneous supination or pronation of the forearm. This pattern of flexion-extension and radial-ulnar deviation coupling is vital in common tasks; however, its evaluation in hand clinics is limited by the availability and ease of current tools. We present the construct, criterion, test-retest, and inter-rater validity of a new circumduction measurement device.
  
  
  METHODS
  Splint volunteers (n = 42) and hand clinic patients (n = 51) were studied to assess different aspects of validity and reliability for the circumduction jig. Known-group validation was used to assess construct validity and demonstrate the ability of the device to differentiate between patients with lesser or greater circumduction values. Criterion validity was demonstrated by comparing the circumduction measures of the device to flexion, extension, ulnar deviation, and radial deviation. Test-retest reliability was established by comparing the results of repeated circumduction measures for the hand clinic patients by 2 blinded, independent researchers, and inter-rater reliability was determined by evaluating the correlation in circumduction measures taken on the same patient by different blinded, independent researchers.
  
  
  RESULTS
  Circumduction measurements significantly decreased (test for trend, p < .01) across the 3 different treatments that represented progressively reduced range of motion, establishing construct validity of the device. Flexion, extension, and radioulnar deviation all correlated significantly with circumduction; the correlation values ranged from 0.46 to 0.82 (p < .01) among all subjects (93 subjects, 228 measurements). Intra-rater reliability was 0.98 (p < .01) for both evaluators, and inter-rater reliability was 0.94 (p < .01).
  
  
  CONCLUSIONS
  The present validation study demonstrated criterion, construct, test-retest, and inter-rater reliability for a newly designed circumduction measurement device.
authors.affiliation: Harvard Medical School, Boston, MA 02215, USA.
authors.forename: Orrin I
authors.initials: OI
authors.lastname: Franko
authors.forename: Shalini
authors.initials: S
authors.lastname: Lal
authors.forename: Thierry
authors.initials: T
authors.lastname: Pauyo
authors.forename: Marcus
authors.initials: M
authors.lastname: Alexander
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Charles
authors.initials: C
authors.lastname: Day
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D015588:Observer Variation; D009983:Orthopedic Equipment; D011336:Probability; D011884:Radius / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology*; D015203:Reproducibility of Results; D012399:Rotation; D012680:Sensitivity and Specificity; D013165:Splints; D014457:Ulna / Q000502:physiology; D014955:Wrist Joint / Q000502:physiology*; D055815:Young Adult